Emotional Consequences of Finasteride: Fool’s Gold

Abstract

Androgenetic alopecia, the gradual, progressive loss of hair frequently results in psychological despair, in part related to changes in self-image. Current androgenetic alopecia treatments are limited to hair transplantation and medications that inhibit dihydrotestosterone, a potent androgen associated with follicular micronization. Users of finasteride, which prevents dihydrotestosterone production, report serious physical and emotional adverse effects, collectively known as post-finasteride syndrome. Psychiatric illnesses and personality traits, specifically neuroticism influence emotional well-being. Limited research exists exploring the psychological corollaries of post-finasteride syndrome and preexisting Axis I and Axis II mental health conditions. The aim of this study was to explore how having a preexisting personal and/or familial history of a psychiatric diagnosis and certain personality traits may influence anxiety and depression among finasteride users. Participants in this online survey completed the Beck Depression Inventory, the Beck Anxiety Inventory, and Ten-Item Personality Inventory. An important finding in this study was that almost 57% ( n = 97) of men reported a psychiatric diagnosis and 28% ( n = 27) had a first-degree relative with a mental health disorder, of this group 17 only had a family history. Nearly 50% of the men surveyed reported clinically significant depression as evidenced by Beck Depression Inventory score and 34% experienced anxiety on the Beck Anxiety Inventory. There were no statistically significant trends in personality traits reported. Results provide evidence on the need to screen for psychiatric history and counseling patients about the potential psychological consequences of finasteride. Prescribing clinicians should carefully weigh the risk/benefit ratio with these patients.

Investigation of the Plausibility of 5-Alpha-Reductase Inhibitor Syndrome

“…In addition, based on the BAI results, 16 subjects reported moderate anxiety and 17 scored a potential cause for concern [32]. A noteworthy finding in this study is that the authors postulated that subjects would score high on the neuroticism personality domain according to the TIPI, but found that this was not the case as subjects were extroverted, agreeable, emotionally stable, and open to experiences.…”

“…A noteworthy finding in this study is that the authors postulated that subjects would score high on the neuroticism personality domain according to the TIPI, but found that this was not the case as subjects were extroverted, agreeable, emotionally stable, and open to experiences. A total of 55% (n = 53) of subjects had an established psychiatric diagnosis prior to initiating finasteride therapy, while 28.8% (n = 27) had a first-degree relative with a mental health disorder [32]. The authors concluded that pre-existing mental health disorders among finasteride users may put this subset of users at an increased risk of developing emotional disorders caused by finasteride therapy.…”

“…The most recent study by Ganzer and Jacobs [32 ]investigated the psychological health of 97 users of finasteride. The authors explored whether having a preexisting personal or family history of a psychiatric diagnosis and certain personality traits influenced anxiety and depression among finasteride users.…”

Research Brief: Self-Reports of a Constellation of Persistent Antiandrogenic, Estrogenic, Physical, and Psychological Effects of Finasteride Usage Among Men

“…In the recently published pilot study using a survey method to characterize psychological (and other) symptoms in men who used finasteride to treat MPB, the cohort reported high rates of psychological symptoms ( Ganzer et al, 2015 ); these effects are much like what we report here using a different approach. Moreover, a recent report has corroborated and extended these results to assess specifically mood symptoms ( Ganzer & Jacobs, 2016 ). Further, in a clinical study, significantly increased depression symptoms and suicidality were reported by three-quarters of the subject group that had discontinued finasteride, compared to about 10% of the control group ( Irwig, 2012a ).…”

Association of Suicidality and Depression With 5α-Reductase Inhibitors

“…sought treatment for persistent adverse effects after the discontinuation of finasteride, 1 mg, there were high rates of depression, and suicidal thoughts, although there is an obvious selection bias in these studies, and some of these findings may be explained by preexisting psychiatric problems. 33,34,52 Strengths and Limitations…”